Vaccine confidence among people who use drugs: A cross-sectional survey

ABSTRACT

Adult immunization coverage remains low in the US, particularly for people who use drugs (PWUD), a population that experiences a disproportionate burden of vaccine-preventable diseases. The extent of and characteristics associated with vaccine confidence (VC) held by PWUD is poorly understood. As VC strongly correlates with vaccine uptake, this cross-sectional study identifies mutable factors associated with VC and quantifies its relationship to immunization status within a highly vulnerable, underimmunized population of PWUD. Using a community-engaged research strategy with select partner organizations hosting syringe exchange programs in Atlanta, Los Angeles, and Las Vegas, USA, we surveyed participants ages 18–69 years served by these organizations from 2019 to 2020. Survey measures included sociodemographics, health behavior including immunization receipt, and vaccine confidence in adult vaccinations using a modified Emory Vaccine Confidence Index (EVCI). The findings reflect relatively low VC among the 1,127 recruited participants, with 56% expressing low VC (EVCI 0–12), 35% medium (EVCI 13–20) and 10% high (EVCI 21–24). EVCI varied by city, with lowest confidence in Atlanta and highest in Las Vegas. VC was associated with past receipt of specific vaccines, including hepatitis A, MMR, Tdap, and influenza. VC varied by specific sociodemographic correlates such as housing insecurity (reduced confidence) and receipt of public benefits or disability (increased confidence). This study identified correlates associated with VC based on site and sociodemographic characteristics for this priority population, highlighting the need for specific interventions to raise VC among PWUD, especially among those experiencing housing insecurity and without public benefits.

KEYWORDS:

• Vaccine confidence
• people who use drugs
• vaccine equity
• vaccine attitudes
• vaccine trust
• vaccine access
• population survey
• cross-sectional survey
• hidden populations
• vulnerable populations

Acknowledgement

We are deeply appreciative to our community partners, including but not limited to TracB, Atlanta Harm Reduction Coalition, The Elizabeth Foundation, Bienestar Human Services, and Asian American Drug Assistance Program, and the clients of those agencies who volunteered their time to complete our survey. This endeavor was a collaborative effort that included a number of staff, including subject matter experts who assisted with instrument development and data collection procedures. We are also grateful for the guidance and insight of all members of HBOU project team. HBOU Project Team: Project Staff/Data Collection Team: Las Vegas: Mehret Girmay, John Olawepo, Sfurti Maheshwari; Los Angeles: Katy Berteau, Elizabeth Wu, Evan Kreuger, Ashleigh Herrera, Tasha Perdue, Mohammed Ahmed, Alberto Gonzales, Do Kin Luong, Cassandra DeWitt, Alicia Morales Perez, Francisco Rodriguez, Jade Dalton, Arthur Sun, Sarah Fiskin, Antonio Shallowhorn, Bernice Lopez, Alexandra (Alex) Michel; Atlanta: Stephanie Richardson, Allen Welty-Green, Priscilla Smith, Tracy Thompson. Community Partners: Las Vegas: TracB (Chelsi Cheatom, Rick Reich); Los Angeles: Bienestar (Robert Contreras, Joanna Barreras, Hugo Aguilar, Esmeralda Limeta); Asian American Drug Abuse Program, Inc. (Terri Reynolds); Atlanta: Atlanta Harm Reduction Coalition (Mojgan Zare, Mona Bennett); Elizabeth Foundation (Tracy Thompson). Subject Matter Experts: Max Gahk, JD; Sarah Hunt; Brian Labus; Ayako Miyashita, JD; Matthew Archibald.

Disclosure statement

Dr. Holloway acknowledges support from the National Institute of Mental Health (P30 MH58107) and the California HIV/AIDS Research Program (RP15-LA-007). Dr. Frew received internal funding from UNLV to facilitate partner engagement. Dr. Spaulding reports recent grants through her institution from the Gilead Sciences, the Bill and Melinda Gates Foundation and the National Institutes of Health; for a research project she has received test kits from Bioltyical Laboratories. These grants are not associated with the scope of inquiry for this study. Dr. Frew reports a relationship with Merck & Co: employment. Dr. Frew was faculty at University of Nevada and did not have a relationship with Merck & Co at the time the study was conducted.

Supplementary material

Supplemental data for this article can be accessed on the publisher’s website at https://doi.org/10.1080/21645515.2022.2123201.

Additional information

Funding

The work was supported by the California HIV/AIDS Research Program [RP15-LA-007]; National Institute of Mental Health [P30 MH58107].